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Peripheral neuropathy is a frequent condition, commonly associated with pain. Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive method of modulation of brain plasticity and is regarded as one of alternative methods to alleviate pain associated with various kind of neuropathies. rTMS is usually performed once a day and the whole therapy of neuropathic pain lasts one week. In a number of recent clinical trials including patients with depression and some other disorders, rTMS was delivered several times a day, which reduced the time of the whole therapy. This approach was termed an accelerated rTMS. The purpose of this study is to investigate feasibility of accelerated rTMS in treatment of neuropathic pain.
Peripheral neuropathy is a frequent condition, commonly associated with pain, which is often drug resistant. Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive method of modulation of brain plasticity. In this method, series of magnetic stimuli are delivered to the cerebral cortex, where they turn to electric current and depolarize repetitively the targeted neurons. If the stimulation is repeated during subsequent days it is capable to modify the activity of targeted cortical area for weeks or even months and by this way to achieve therapeutic effect. rTMS is most commonly used to treat drug-resistant depression but a number of other psychiatric and neurologic conditions is increasingly being regarded as therapeutic indication for rTMS. In patients suffering from neuropathic pain rTMS is delivered with high frequency, over primary motor areas (PMA). Stimulation of PMA should result in modulation of thalamic activity, achieved by antidromic excitation of thalamocortical connections. rTMS is usually performed once a day and the whole therapy of neuropathic pain lasts one week. In a number of recent clinical trials including patients with depression and some other disorders, rTMS was delivered several times a day, which reduced the time of the whole therapy. This approach was termed an accelerated rTMS. The purpose of this study is to investigate feasibility of accelerated rTMS in treatment of neuropathic pain.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Active repetitive transcranial magnetic stimulation | Experimental | 10 hertz (Hz) rTMS will be administered over the primary motor area. Therapy will include 6 sessions (three sessions in two consecutive days). In every sessions 1500 magnetic pulses of 90% of the resting motor threshold intensity will be elicited. |
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| Sham repetitive transcranial magnetic stimulation | Sham Comparator | Sham stimulation will mimic the active one except that the stimulating coil will be held perpendicularly to the scalp, which assures similar impression as the active stimulation but prevents that significant magnetic field will reach brain tissue. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Active repetitive transcranial magnetic stimulation | Device | High frequency rTMS over the primary motor area to induce the long term potentiation of primary motor areas for the muscles of upper extremity. |
| Measure | Description | Time Frame |
|---|---|---|
| Visual Analogue Scale of Pain Severity after rTMS | An analog scale of the length of 100 millimeter. Total score of 100, with higher scores representing more severe pain. Change from baseline score in the Visual Analogue Scale to the measurement taken after finishing rTMS. | Through study completion, an average of 1 year. |
| Visual Analogue Scale of Pain Severity First Follow-up | An analog scale of the length of 100 millimeter. Total score of 100, with higher scores representing more severe pain. Change from baseline score in the Visual Analogue Scale to the measurement taken after two weeks after finishing rTMS. | Before rTMS, up to one day after finishing rTMS. |
| Visual Analogue Scale of Pain Severity Second Follow-up | An analog scale of the length of 100 millimeter. Total score of 100, with higher scores representing more severe pain. Change from baseline score in the Visual Analogue Scale to the measurement taken after four weeks after finishing rTMS. | Before rTMS, four weeks after finishing rTMS. |
| Measure | Description | Time Frame |
|---|---|---|
| Numeric Pain Severity Scale after rTMS | Total score 10, with higher scores representing more severe pain. Change from baseline score in the Numeric Pain Severity Scale to the measurement taken after finishing rTMS. | Before rTMS, up to one day after finishing rTMS. |
| Numeric Pain Severity Scale First Follow-up |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jakub M Antczak, MD | Contact | +48 795 421 153 | jakub.antczak@uj.edu.pl | |
| Gabriela G Rusin, MD | Contact | +48 601 661 607 | gabriela.rusin@doctoral.uj.edu.pl |
| Name | Affiliation | Role |
|---|---|---|
| Tomasz Klupa, Professor | Jagiellonian University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jagiellonian University Medical College | Recruiting | Krakow | 31008 | Poland |
After completing the study, the age and gender of participants as well as the scores and results of all outcome measurements made at baseline, after rTMS, at the first and at the second follow-up will be made available to other researchers on request.
The data will become available after the study results will be published.
On request sent by e-mail to jakub.antczak@uj.edu.pl
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| ID | Term |
|---|---|
| D010523 | Peripheral Nervous System Diseases |
| D009437 | Neuralgia |
| ID | Term |
|---|---|
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
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Parallel Assignment. Patients will be randomly assigned to active or to sham stimulation.
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Triple (Participant, Investigator, Outcomes Assessor). Sham stimulation will be provided by holding the stimulating coil perpendicularly to the scalp, which assures similar impression as during active stimulation but prevents significant magnetic field to reach the brain tissue.
| Sham repetitive transcranial magnetic stimulation | Device | Sham stimulation to mimic the high frequency rTMS over the primary motor area. |
|
Total score 10, with higher scores representing more severe pain. Change from baseline score in the Numeric Pain Severity Scale to the measurement taken two weeks after finishing rTMS. |
| Before rTMS, two weeks after finishing rTMS. |
| Numeric Pain Severity Scale Second Follow-up | Total score 10, with higher scores representing more severe pain. Change from baseline score in the Numeric Pain Severity Scale to the measurement taken after four weeks after finishing rTMS. | Before rTMS, four weeks after finishing rTMS. |
| Neuropathic Pain Symptoms Inventory after rTMS | Total score 120, with higher scores representing more severe pain and other symptoms of neuropathy. Change from baseline score in the Neuropathic Pain Symptoms Inventory to the measurement taken after finishing rTMS. | Before rTMS, up to one day after finishing rTMS. |
| Neuropathic Pain Symptoms Inventory First Follow-up | Total score 120, with higher scores representing more severe pain and other symptoms of neuropathy. Change from baseline score in the Neuropathic Pain Symptoms Inventory to the measurement taken two weeks after finishing rTMS. | Before rTMS, two weeks after finishing rTMS. |
| Neuropathic Pain Symptoms Inventory Second Follow-up | Total score 120, with higher scores representing more severe pain and other symptoms of neuropathy. Change from baseline score in the Neuropathic Pain Symptoms Inventory to the measurement taken four weeks after finishing rTMS. | Before rTMS, four weeks after finishing rTMS. |
| Athens Insomnia Scale after rTMS | Total score 24, with higher scores representing more severe insomnia. Change from baseline score in the Athens Insomnia Scale to the measurement taken after finishing rTMS. | Before rTMS, up to one day after finishing rTMS. |
| Athens Insomnia Scale First Follow-up | Total score 24, with higher scores representing more severe insomnia. Change from baseline score in the Athens Insomnia Scale to the measurement taken two weeks after finishing rTMS. | Before rTMS, two weeks after finishing rTMS. |
| Athens Insomnia Scale Second Follow-up | Total score 24, with higher scores representing more severe insomnia. Change from baseline score in the Athens Insomnia Scale to the measurement taken four weeks after finishing rTMS. | Before rTMS, four weeks after finishing rTMS. |
| Bilateral Dynamometric Assessment of the strength of the foot extension after rTMS | Change from baseline strength of the foot extension to the measurement taken after finishing rTMS. | Before rTMS, up to one day after finishing rTMS. |
| Bilateral Dynamometric Assessment of the strength of the foot extension First Follow-up | Change from baseline strength of the foot extension to the measurement taken two weeks after finishing rTMS. | Before rTMS, two weeks after finishing rTMS. |
| Bilateral Dynamometric Assessment of the strength of the foot extension Second Follow-up | Change from baseline strength of the foot extension to the measurement taken four weeks after finishing rTMS. | Before rTMS, four weeks after finishing rTMS. |
| D012816 |
| Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |